| NPI | 1316289473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 119404) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05751200) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2019-05-02 |